The CRNA Workforce: Too many, too few or just right? Programs, Students, Clinical Sites, Accreditation John M. O Donnell CRNA, MSN, DrPH jod01@pitt.edu
Objectives 1. Describe trends in programs, students and graduates 2. Analyze the workforce variables which impact the CRNA job market including certification 3. Discuss issues faced by programs, students, providers and the profession when considering workforce trends
Nurse Anesthesia Education Many changes. Accreditation Certification (NBCRNA) Students have changed Generational differences Consumers Debt Technology has changed the dynamic On line programs.
Accreditation Council on Accreditation of Nurse Anesthesia Educational Programs (COA)
COA Sets case numbers Accredits programs Site visitors Standards and Guidelines Complies with USDE and CHEA Handles complaints Sets standards
CRNA Education Programs 1976 194 programs 1980 161 programs same number of graduates greatest drop in CRNA programs contrasted by significant increases in MD residencies 1990 82 programs DHHS study: need to AT LEAST triple CRNA grads by 2010 750 X 3 = 2250 1995 87 programs 1999 82 programs (619 clinical sites) 2/2004 88 programs (1016 clinical sites) 2/2005 94 programs 2/2006 99 programs (1300+ clinical sites) 11 new programs eligible for application in 2006 1/2007 106 programs (1500+ clinical sites) 1/2009 108 programs (> 2000 clinical sites) 1/2010 109 programs (2077 clinical sites) 1/2011 112 programs ( > 2200 clinical sites)
AANA Membership Info 2010 2011 ~6,000/~20,000 respondents
Total Membership 45, 910
Certified, Recertified, Students 2011
Gender Proportions: 2011
Gender Trend: Annual Report 2011
February 09.. 108 programs Nurse Anesthesia Programs, Graduates and Clinical Sites 3000 2500 2000 2417 2077 1500 1000 500 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008* 2009* Now 112 Programs Graduates Clinical Sites * Projected Courtesy, Dr. Frank Gerbasi, Director of Accreditation, AANA COA, Feb 2009
Year Grads 1980 1023 1988 574 1990 750 1994 981 1996 1000 1997 934 1999 948 2001 1159 2003 1500 2006 1946 2007 2021 2008 2161 2009 2239 2010 2417 CRNA Graduates
Possible Responses Advantages CRNA vacancy rates have been as high as 10% not sustainable Failure to fill vacuum = alternative providers Better relationships with industry leaders Helps to change the workforce demographic More membership = more influence Quality opportunity Educational opportunity Disadvantages (fears) Competition for jobs Competition for cases Salary compression? Not enough clinical sites? Quality Shortage of qualified program faculty Pressurizes the clinical system Sites Coordinators Instructors
Increases 1999 2009 (10 yrs) Graduates: 236% Clinical sites: 317% Programs: 31% Barometer of issue PD/faculty turnover Courtesy, Dr. Frank Gerbasi, Director of Accreditation, AANA COA, Feb 2009
Program Director/Faculty Turnover 1998 2010 average 15% 2005 22% Highest reported % 21/94 programs Other faculty % turnover is higher Pressures Doctoral education Clinical pushback Too much work Endless job Courtesy, Dr. Frank Gerbasi, Director of Accreditation, AANA COA, Feb 2009
What About Applicants? Exact numbers unknown some programs report economy is affecting Over the last 10 years significant excess of applicants 150 220 at Pitt over last 5 years Major recruiting tool at undergraduate level Obstacles to early admission as in dentistry, medicine etc
COA 2010 Annual Report
What does the NBCRNA do and who is the Director? Certification/Re certification Karen Plaus
Changes in Certification 2007 Now Reorganization into National BOARD of Certification and Recertification of Nurse Anesthetists Council on Certification Council on Recertification Changes in the exam Minimum of 100, Max of 170 Alternative formats
Certification Exam Changes Scale of certification exam has also changed Pass score remains 450 Scale used to be 300 600 300 = I signed my name (same) 600 = maximum reported score NOT PERFECT Many people mis interpreted this as a perfect score Program web sites reported results this way 300 900
Other Changes in Certification Candidate eligibility as of Jan 1, 2009 NBCRNA has determined that if a candidate admits to having been on probation for academic integrity, cheating or unethical behavior.they have the right to investigate and deny certification examination eligibility regardless of the decision reached at the educational program Designed to protect the integrity of the exam
Change in Rigor and Test Map Rigor has increased Alternative items Pass rates as low as 86% for 1 st time takers Average in last 5 years ~90% Test map has changed to emphasize Professional issues, Equipment, Instrumentation, Technology De emphasizes Basic principles, Basic sciences
AANA Assembly of School Faculty February 2008 Announced new testing approach Multiple, multiples (pick all of the following which are correct, which 4 choices, how many of the following.) Interactive models (eg regional anesthesia) Screen based formulas and calculations (calculator will hover)
NBCRNA Changes: When and How Often Prior to 2009 Fail could take the exam as many times as desired 2009 (applies retroactively to grads from 2007) Fail can retake up to 4 times in one year Have a total of 2 years post graduation to pass If unsuccessful? Repeat a full and unabridged course of study in a Nurse Anesthesia Program
Certification Bottom Line Testing and the entire process is more rigorous than it used to be The penalty for not being able to pass the exam is more severe
Have Changes in Student Numbers Hurt CRNA. Employment settings Income How they are treated and valued
Merwin 2008, AANA Journal Merwin take home: there are mismatches between CRNA supply and hospital needs. It is geographic.
Example: Minneapolis, MN 2010 AOSF Graduate from a Minneapolis program indicated they could not find a job in the twin cities Did not want to relocate..
AANA Annual Report 2011 Primary Practice Setting
AANA Annual Report 2011 Sources of Income
AANA Annual Report 2011 Full vs. Part time
AANA Annual Report 2011 Primary Position
Practice Specialization
AANA Annual Report 2011 Total Compensation Statistics By Setting
AANA Annual Report 2011 Compensation Trend
Compensation Trend by Employment 2001 to 2010
AANA Annual Report 2011 Insurance Benefits
Are We Valued? What About Practice? Main Professional Concerns?
AANA Annual Report 2011 Practice Barometer: Work Environment
AANA Annual Report 2011 Practice Barometer: Techniques
AANA Annual Report 2011 Practice Barometer: Trauma
AANA Annual Report 2011 Major Professional Issues
What does the workforce look like from an age perspective? We are getting more..
Experienced! 60% of practicing CRNAs have more than 10 years of experience average age 49.8
Years of Practice 2011 60% > 10 years
AANA Annual Report 2011 Age Demographic We are aging as a profession 55% 50
AANA Annual Report 2011 Age Demographic Trend
AANA Annual Report 2011 Retirement Projection 50% by 2022
Retirement So if 50% of CRNAs retire over the next 10 years that would be 0.5 X 46,000 = 23,000 If we continue to produce 2400 students per year = 2400 X 10 = +24,000 Net gain of 1,000 providers over 10 years given a steady supply
Take homes More.. Programs Students We need to be Clinical sites Clinical faculty Opportunity for teaching and learning Competition?? High levels of: Satisfaction Salary Benefits
Threats Economy CRNAs did not retire. Graduates numbers are increased Control of graduates (no F S ratio required) Job market tight in some areas of US Alternative providers Politics getting more serious Failure to maintain quality
Workforce Positives We are affordable, safe and offer high quality in case loads in operating rooms and non traditional locations in public expectation for painless procedures in worry about patient satisfaction use of non physician providers IOM reports Healthcare reform
Discussion